Provider Demographics
NPI:1902910268
Name:GUO, JIN LIANG (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JIN LIANG
Middle Name:
Last Name:GUO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11929 45TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9160
Mailing Address - Country:US
Mailing Address - Phone:425-299-8218
Mailing Address - Fax:
Practice Address - Street 1:4320 196TH ST SW STE D
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6753
Practice Address - Country:US
Practice Address - Phone:425-774-8758
Practice Address - Fax:425-672-8944
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004502363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical